Medicare 2026

The Two Medicare Structures Available in Jersey City

In Jersey City, turning 65 usually means facing a fork in the road. On one side is Original Medicare, often paired with a Medigap policy and a stand-alone Part D drug plan. On the other side is Medicare Advantage, a single plan from a private insurer that bundles your coverage together. Both are legitimate ways to get your Medicare benefits, but they are built very differently — and understanding that structure is the first step to choosing well.

Two different structures, not just two different prices

Original Medicare is the traditional program run by the federal government. Part A covers hospital stays, and Part B covers doctor visits and outpatient care. You can generally see any provider in the country who accepts Medicare, and there is no network to worry about.

Medicare Advantage, sometimes called Part C, is different. Private insurance companies contract with Medicare to deliver your Part A and Part B benefits — and usually Part D drug coverage — through a single plan. These plans typically have provider networks (HMO or PPO) and their own rules for referrals and prior authorization. Many also include extras that Original Medicare does not cover, such as routine dental, vision, or hearing benefits.

Neither path is "better." They are structured for different priorities.

Where Medigap fits in

Original Medicare does not have an annual out-of-pocket limit on its own. That is where Medigap — also called Medicare Supplement Insurance — comes in. Medigap policies are sold by private insurers and help pay some of the costs Original Medicare leaves behind, like coinsurance, copayments, and deductibles.

A key point: Medigap only works alongside Original Medicare. You cannot use a Medigap policy with a Medicare Advantage plan. And if you want drug coverage on the Original Medicare + Medigap path, you generally need to add a stand-alone Part D plan.

There is also a timing rule worth knowing. You get your strongest Medigap rights — including guaranteed acceptance regardless of health — during your six-month Medigap Open Enrollment Period, which starts when you are 65 and enrolled in Part B. After that window, insurers in most states can consider your health history.

What Jersey City residents should know locally

Jersey City is in Hudson County, where residents have access to a range of Medicare Advantage and Part D plans offered by multiple carriers. Plan availability is set at the county level by the Centers for Medicare & Medicaid Services (CMS), so two neighbors on the same block will see the same list of plans, but a friend across the Hudson in New York may see something different.

For a current, personalized list, the Plan Finder at medicare.gov lets you enter your ZIP code and your prescriptions to see what is available in Hudson County. New Jersey's State Health Insurance Assistance Program (SHIP), known locally as NJ SHIP, offers free one-on-one counseling and does not sell insurance.

Costs to understand for 2027

Whichever path you choose, some program-level figures apply for 2027:

• Part D out-of-pocket cap: $2,400 in 2027 (up from $2,100 in 2026). Once your out-of-pocket drug spending hits that number, you pay nothing for covered drugs the rest of the year.
• Part D maximum deductible: $700 in 2027 (up from $615 in 2026).
• The coverage gap ("donut hole") is gone. As of 2025, Part D has three phases instead of four.
• Medicare Prescription Payment Plan: An optional program that lets you spread your drug costs across the calendar year in monthly payments instead of paying at the pharmacy counter.
• IRMAA: Higher-income beneficiaries pay an income-related surcharge on Part B and Part D premiums. In 2026, IRMAA begins above $109,000 for a single filer.

Enrollment windows to circle

• Annual Enrollment Period (AEP): October 15 – December 7. You can join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect January 1.
• Medicare Advantage Open Enrollment Period: January 1 – March 31. If you are already in a Medicare Advantage plan, you can switch to a different one or return to Original Medicare (and add a Part D plan).
• Initial Enrollment Period: The seven-month window around your 65th birthday.
• Medigap Open Enrollment: Six months starting when you are 65 and enrolled in Part B.

Missing these windows can mean waiting, late-enrollment penalties, or losing your best chance at Medigap without medical underwriting.